Osteomyelitis caused by Sporothrix schenckii in an immunocompetent patient

Abstract

Sporotrichosis is the most common subcutaneous mycosis in South America and its association with zoonotic transmission remains a relevant public health problem in Rio de Janeiro, Brazil. The disease most commonly presents as subacute or chronic cutaneous lesions, although dissemination to various organs and systems occurs in rare cases, mainly in immunosuppressed individuals. This report describes a case of sporotrichosis with severe bone and subcutaneous damage in an immunocompetent patient who did not exhibit the characteristic skin lesions of sporotrichosis, including ulcers, nodules, and lymphangitis.

Ploidy Determination in the Pathogenic Fungus Sporothrix spp.

“…Subsequently, in the majority of cases, nodules develop in the infection site leading to ulceration (Kauffman, 1999). Poorly controlled sporotrichosis can disseminate to distant anatomical sites, including bones, lungs, and central nervous system (Ferreira et al., 2016; Hassan et al., 2016; Rodrigues et al., 2016; Mialski et al., 2018). Apart from being a global health problem, sporotrichosis is hyperendemic in Brazil, mainly due to the zoonotic and crossed transmission of S. brasiliensis from infected felines (Montenegro et al., 2014; Sanchotene et al., 2015; Gremião et al., 2017).…”

Diagnosis of chronic osteomyelitis complicated with mycotic infection

“…Gamaletsou Immunosuppression from hormone, chemotherapeutic agents used for oncologic and autoimmune diseases, hemodialysis and organ transplantation is a risk factor for mycosis. Immunodeficiency caused by HIV is another contributing factor [11][12][13][14][15][16][17]. The studies performed by the International Working Group on the Diabetic Foot showed that mycosis was detected along with bacterial flora in some diabetic patients [18].…”

“…Pathomorphological examination of biopsy sample at the nidus of purulent infection is the basic diagnostic criterion. Diagnostic biopsy can be produced as part of preoperative preparation of the patient [9][10][11][12][13][14][15][16][17]. Risk grading scale for mycosis was developed with the above factors in mind marking presence/absence of the signs in the right-hand column (Table 9).…”

“…In the last decade, there has been an increase in the incidence rate of mycoses in patients after injuries and/or operations performed on limb segments and major joints [9][10][11][12][13][14][15][16][17]. Mycoses are difficult to diagnose early [8][9][10][11][12][13][14][15][16][17]. The mycotic flora may mimic the bacterial flora being present in the osteomyelitic nidus and primarily identified in the wound exudate.…”

“…The mycotic flora may mimic the bacterial flora being present in the osteomyelitic nidus and primarily identified in the wound exudate. This results in prolonged antibiotic therapy without use of antifungal medicines and finally leads to repeated revision procedures [9][10][11][12][13][14][15][16][17]. Such a continuous inadequate treatment can reduce immune system response, promote growth of persistent bacterial strains and spread of fungal infection.…”